The cornerstone of successful treatment of rheumatoid arthritis (RA) is an early diagnosis and aggressive medical therapy. In addition, though, there are non-drug therapies that can be beneficial for many patients.

The following is a rundown of things that help patients at our center.

While glucosamine sulfate/ chondroitin have been used mainly to treat osteoarthritis (OA) of the knee, it can be helpful in the patient with both RA as well as OA. There is very little data regarding its use in patients with both conditions. However, many patients report that symptoms improve with the addition of a good quality form of glucosamine and chondroitin.

If a patient is a smoker, there is abundant evidence indicating that smoking increases the risk of developing RA. In one study looking at more than 350,000 women, those who smoked more than 25 cigarettes per day had a relative risk of 1.4 of developing RA compared with those who never smoked. In addition, patients with RA who smoked were more likely to develop aggressive joint disease associated with more joint damage, rheumatoid nodules (swelling under the skin near joints), and higher levels of rheumatoid factor, a blood test that correlates closely with disease activity.

Physical and occupational therapy can be very helpful for those patients with significant RA. In addition to range of motion, muscle strengthening exercises are extremely important. The goal of an early muscle-strengthening program is to prevent long-term disability and improve physical function. There is significant data indicating that patients with RA who participate in strength-training programs show overall improvement in muscle strength and functional capacity. Beneficial effects of occupational therapy (OT) in patients with established RA, while sparse, do indicate that it is helpful. In our clinic, we feel that patients with significant hand and wrist problems benefit greatly from OT evaluation.

Non-impact aerobic exercise is critical for a number of reasons. It improves endurance, reduces fatigue, increases muscle strength, reduces pain (through endorphin production in the brain), and also gives an RA patient a sense of control over their disease. Non impact aerobic exercise can be done with swimming, a stationary (or regular bicycle), or elliptical trainer.

Dietary fish oil supplement has been shown to decrease signs and symptoms of RA. Fish oil contains omega-3 long-chain polyunsaturated fatty acids. These fatty acids inhibit the metabolism of arachidonic acid into pro-inflammatory substances such as prostaglandins. The clinical benefits are delayed for 2-3 months and require moderately high doses of 3-7 g per day. A recent study noted additional improvement in RA symptoms and functional capacity when dietary fish oil was combined with olive oil.

The use of various herbal and vitamin supplements that contain antioxidants and therapeutic amounts of anti-inflammatory compounds such as gamma linolenic acid may also provide relief.

Complementary therapies such as yoga, t'ai chi, meditation, prayer, chiropractic (in selected cases), acupuncture, music therapy, hypnosis, guided imagery, cold laser, ultra high frequency electrical stimulation, and so forth all have their place in the pantheon of therapy.

This is where treatment of arthritis becomes both an art as well as science.